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The Three Faces of Psychogastroenterology: Science, Practice, and the Patient

Published:October 19, 2022DOI:https://doi.org/10.1016/j.gtc.2022.07.010
      Each article in this special issue is grounded by Drs Ballou and Feingold’s article relating to how the science of stress, resilience, and the gut-brain axis applies across the spectrum of digestive disorders. Drs Brjann Ljotsson and Helen Murray expand on these principles of stress and resilience and remind us of the mediators, moderators, and context of behavior change as we refine our brain-gut behavior therapies. We attempt to address the significant lack of access to experts providing gastropsychology services through Drs Ruby Greywoode and Eva Szigethy’s article relating to the future of digital GI behavior therapeutics.
      Two additional themes permeate this special issue. First, psychogastroenterology is patient centered. We start and end the issue with the voices of patient advocates. In the first article, patient advocate Johannah Ruddy partners with renowned stigma researcher Dr Tiffany Taft. In the final article, Tina Aswani-Omprakash partners with Neha Shah, RD to share her story and considerations around disparities, culture, and food-related quality of life.
      The second theme reflects the diverse role of the practicing gastropsychologist. In addition to a practical article by Dr Sarah Kinsinger on how to work with a gastropsychologist with varying levels of resources, you will see articles on how a gastropsychologist might approach disorders such as Celiac disease, eosinophilic esophagitis, chronic pancreatitis, inflammatory bowel disease, celiac disease, and obesity. You will see the gastropsychology approach to common extraintestinal symptoms seen across digestive disorders, including sexual dysfunction, sleep disturbances, fatigue, and disordered eating. You will also see how gastropsychologists might work with special populations, including adolescents transitioning into adult-centered care or patients with a trauma history.
      There are a few themes, however, that are not featured prominently. We did not cover pediatric psychogastroenterology; this could be its own special issue! Second, we did not dedicate an article to cooccurring mental health disorders, such as anxiety and depression, while present in up to 30% of individuals living with a chronic digestive disorder and a key driver of poor outcomes, these have not only been the focus of several previous articles for the past decade but their presence often distracts our gastroenterologist colleagues from recognizing the disease-interfering self-management factors that drive the majority of GI symptoms and outcomes in the other 70% of patients. By demonstrating the range of roles and services offered by a gastropsychologist outside of traditional mental health services, we hope to underscore our contribution to value-based care and acquire buy-in for our services from our health system administrators, pharmacy benefit managers, employers, and insurance companies.